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Sexuality, politics and HIV

The complex of funding, widespread attention, and advocacy around HIV has enabled queer individuals to talk openly about their sexual desires and created space for more political subversion and critiques of sexuality. At the same time, HIV activism has limited the discussion around sexual desire by focusing on disease, “risk” groups, and epidemiology, writes Padma Govindan

The complex of funding, widespread attention, and advocacy around HIV has enabled queer individuals to talk openly about their sexual desires and created space for more political subversion and critiques of sexuality. At the same time, HIV activism has limited the discussion around sexual desire by focusing on disease, “risk” groups, and epidemiology, writes Padma Govindan

The relationship between sexuality and the politics around HIV treatment and prevention is a complex one. Twenty-three years after the first HIV case was diagnosed in India, and on the cusp of a ruling that could amend the Indian Penal Codes Section 377 (the law that criminalises homosexuality in India), (1) the time has come for a critical assessment of the role of the massive HIV funding and prevention industry in shaping both the activist and public discussion around issues of sexual desire and identity, particularly for gay individuals and communities.

The sheer amount of money from international aid agencies funneled into HIV prevention and treatment work in India, coupled with more than 15 years of research and prevention advocacy by state-level actors, non-governmental organisations (NGOs), civil service organisations and community-based organisations, has created a public discourse in which HIV is treated as the dominant public health and social crisis in India. Within the circle of gender and sexuality activists (including those working on issues such as sex workers rights and queer advocacy), the attitudes towards HIV activism range from ambivalence and frustration to gratitude that the widespread panic on the HIV epidemic has created a public discourse around non-heterosexual desire for the first time.

This article explores how the complex of funding, national attention, and non-profit advocacy around HIV actually enabled queer individuals to talk openly about their sexual desires, and created space for more political subversion and critiques of sexuality. It also explores to what extent HIV activism limited the discussion around sexual desire by focusing on disease, “risk” groups, and epidemiology.

The coalescing of the queer movement in India provides a productive lens through which to assess how HIV activism influenced sexual identity and desire in India. The origin story, as it were, about queer activism in India is predicated on the emergence of HIV as a public health threat to gay men and transgender women and the attendant growth of the HIV prevention discourse around building solidarity for “risk” groups. (2) Networks of sexual minorities that grew in response to the need for education around HIV prevention and treatment became empowered to address other issues of stigmatisation and violence that they faced in their everyday lives. For example, kothi (man who adopts feminine modes of behaviour and dressing) members of community-based organisations at first focused on peer education on HIV but eventually came to find that their marginalisation as same-sex desiring men prevented their access to HIV treatment and basic medical care; this marginalisation also exposed them to the risk of police and public harassment for engaging in advocacy work around HIV. Thus, the necessity of addressing other vectors of discrimination in the quest to provide education on HIV prevention-sexual identity, gender presentation, and sex work-led to a development of a political consciousness around sexuality and gender for gay men and transgender women.

In his monograph Queer: Despised sexuality, law, and social change, Bangalore-based lawyer and activist Arvind Narrain compellingly traces the trajectory of this movement from public health concerns to political activism: “At a more pragmatic level, the HIV/AIDS pandemic and the consequent identification of high risk groups such as MSM (men who have sex with men) has greatly opened up spaces for discussion around sexualityâ€¦ (and) resulted in funding for MSM intervention projects and spurred the development of sexuality minority networks. As networks of activists began to form, the collective nature of assertion emerged as the community started responding to issues of direct concern through public protests against extortion and violence, as well as questioning unjust colonial laws.” (p 11)

Narrains argument is born out by the history of the public interest litigation case against IPC Section 377 currently awaiting judgment in the Delhi High Court. The petition itself arose from police harassment against employees of the Bharosa Trust, an HIV-prevention organisation associated with the Naz Foundation in Delhi. In 2001, employees of Bharosa were found handing out condoms and literature about HIV to male and transgender women sex workers in Lucknow and were arrested for abetting crimes under Section 377. The Naz Foundation filed a petition to amend the law on the basis of public health interests, a petition that was later co-impleaded by Voices Against 377, a queer activist coalition, on the grounds of human rights protections for queer people. As a result, one can clearly see the intersections between advocacy around HIV prevention and an increased ability for queer communities to agitate for other, non-health related rights and protections.

However, the question remains whether the massive structures around HIV prevention and treatment in India, from the flood of international funding to the rapid growth of community-based organisations, have resulted in a large-scale questioning of the structures of inequality that reproduce sexual violence and discrimination. For example, within the queer community itself, there is a tremendous degree of frustration about the complete absence of structures to oversee HIV funding for non-profit organisations. HIV prevention and funding are inextricably linked, so much so that Elizabeth Pisani, author of the book The Wisdom of Whores: Bureaucrats, brothels, and the business of AIDS, has frankly termed the complex of HIV-funding programmes an “industry”.

Pisani is herself a professional epidemiologist and has worked as a consultant for several HIV funding bodies, including UNAIDS, during the first years of its inception, and so describes the development of UNAIDS and other funding bodies in terms of their initial goals and eventual politics: “Money, of course, follows the dominant ideologies. But it also sucks in people who don’t really care about the problem, who are truly queasy about sex and drugs, but who want some of the cash. When AIDS was unfashionable, we had thought that more money would make it easier to do the right things to prevent a wider epidemic. Now that it is a boom industry, it has become clear that money can actually be an obstacle to doing the right thing.” (p 11)

This is very true in terms of dealing with inefficiency and lack of skills within administering agencies and there is certainly a simmering resentment within the non-profit sector that organisations whose missions never involved disease prevention or control are now successfully applying for funding to conduct HIV prevention related projects that they never intend to complete. However, there is a larger issue at stake here than simply the misuse of funds by NGOs. It is that the sheer amount of money at play pushes NGOs, collectives, and grassroots community organisations into adopting the priorities of international funding bodies in order to access urgently needed funds-often sacrificing more nuanced political missions and commitments to broader goals of social justice.

As a result, there is also a growing sense among sexuality activists that HIV work has focused with such a high degree of exclusivity on issues of prevention, that queer sexual identities are once again being stigmatised by their association with HIV. As Geetanjali Misra and Radhika Chandiramani state in their essay Unlearning and Learning: The Sexuality and Rights Institute in India: “On the one hand, sexual identity can offer advantages to the individual. It can help provide connections to other people with a similar identityâ€¦and form a basis for advocacy and protection. On the other handâ€¦labels can also have negative effects. Firstly, they can constrain individuals within a particular identity or category. Secondly, they can reinforce the difference of the named group.” (p 140) That is to say, that HIV activism has opened the arena for talking publicly about sexual behaviour, but it has not necessarily made that conversation less stigmatising to the subjects of HIV prevention efforts-particularly with regards to evaluation of gay and transgender sexual practices as “high risk”. The label of risk (and its attendant implication of irresponsibility) raises the possibility of a reproduction of dominant sexual hierarchies: straight equals healthy and good, gay or transgender equals diseased, selfish, and irresponsible.

To name a group as “high risk” (as MSMs, gay men, transgender women, and female sex workers have been named in the Indian context), accomplishes several problematic things. One, it stigmatises both the identities and sexual behaviours of certain marginalised groups as “risky”, and by implication, irresponsible, selfish, dirty, and degenerate. Niranjan Karnik, a professor of social medicine at the University of California San Francisco, describes this complex system of beliefs and values around HIV in this way: “HIV/AIDS and its conceptual baggage are not simply transmitted outward from some central information centreâ€¦Rather, these processes are dynamic and rely on the transmission of scientific information along with the symbolic, cultural, and interpretive meanings from which to make sense of the science.”

Simultaneously, the terrain afforded by HIV activism for at least talking about sexual behaviour afforded to gay men and transgender women (and to a lesser extent, sex workers) is denied to lesbian and bisexual women and transgender men, who are not seen as being a “risk” group. That is to say, the discourse around risk and prevention silences the issue of sexual pleasure and reproduces various forms of sexual marginalisation for men and transgender women, but lesbian women and transgender men are not even afforded that dubious distinction. Queer women and transgender men cannot use the risk of HIV infection as a site of political organising since their sexual behaviour is assumed to be non-penetrative-irrespective of the fact that many queer women and transgender men engage in penile-vaginal sex because they have been forced into marriage, because theyre sex workers, or because they happen to like penetrative sex with men and transgender women on occasion. Their very existence is made invisible by the limitations of the dominant HIV discourse (as well as structures of patriarchal violence), and as a result they have neither the access to funding for advocacy work nor the potential political platform to expand the available public dialogue to include sexual rights or identities. Thus, it becomes clear exactly how complicated the business of naming and identity is when implicated by questions of disease, public health, and access to resources.

As another complication to the dominant discourse of HIV prevention in India, in a purely disease-prevention context where “high risk” sexual behaviour is reduced to a series of injunctions against contracting HIV, where is the space for the discussion of pleasure or empowerment through sexuality? Sex, after all, is about more than just disease, but about wildly intense physical and sexual desires. Elizabeth Pisani states this in the simplest terms possible: “The truth is, people don’t have sex in boxes.” (p 48) Pisani makes it clear in her ethnographic account of working as an epidemiologist for organisations such as the World Health Organisation that the complexity of reasons why people pursue sexual pleasure simply cannot be reduced to the realm of the rational that is assumed by HIV prevention models, and such an analysis de-legitimises sex as a locus of pleasure and fulfilment.

The space created by funding for and activism around HIV prevention and treatment remains both a productive as well as a highly problematic arena for embedding critiques of sexual inequality or political consciousness around sexuality. HIV simply cannot be understood without talking about other forms of oppression, and since the agendas of international funding agencies address HIV purely through the lens of prevention around behaviour rather than disenfranchisement and empowerment, there are few opportunities for organisations on the ground in India to make HIV prevention part of a larger movement for social justice. At a time of tremendous upheaval around sexual rights and sexual policing by the State, the role of HIV prevention efforts in shaping our public debates must continue to be critically assessed. Ultimately, HIV activism and public policy must strive to reflect the diversity of HIVs most vulnerable victims as well as the complexities of their desires-that is, to make the HIV prevention movement something greater than HIV itself, an avenue for political consciousness and libratory social practices in the arena of sexuality.

(Padma Govindan is founder and co-director of the Shakti Centre, a sexuality advocacy and research non-profit organisation in Chennai, India) InfoChange News & Features, June 2009